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Intensive Insulin Therapy (Basal-Bolus).

Ana Chico1,2,3, Rosa Corcoy1,2,3

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Intensive insulin therapy (IIT) improves glycemic control in T1DM and T2DM, but increases hypoglycemia risk. For T1DM, IIT aids HbA1c reduction but causes weight gain; for T2DM, weight gain is not observed.

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Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Diabetes Mellitus Research

Background:

  • Intensive insulin therapy (IIT) aims for near-normal glycemic control using basal-bolus (BB) regimens.
  • The benefits of IIT must be weighed against its treatment burden, including glycemic control and complication reduction.

Purpose of the Study:

  • To review the effects of IIT versus conventional insulin treatment in Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM).
  • To summarize findings on glycated hemoglobin (HbA1c), hypoglycemia, insulin doses, and weight changes.

Main Methods:

  • A systematic PubMed search identified randomized control trials (RCTs) comparing IIT with conventional insulin therapy.
  • Studies focused on T1DM and T2DM subjects, analyzing outcomes like HbA1c, hypoglycemia, insulin requirements, and weight.

Main Results:

  • In T1DM (11 RCTs), IIT consistently reduced HbA1c but increased severe hypoglycemia and weight gain; insulin doses showed no clear effect.
  • In T2DM (2 RCTs), IIT improved HbA1c and increased hypoglycemia, but without significant weight gain. One study used a BB schema.

Conclusions:

  • IIT is optimal for T1DM HbA1c reduction, despite increased hypoglycemia and weight gain.
  • IIT also improves HbA1c in T2DM, with more hypoglycemia but not necessarily weight gain.
  • Basal-bolus insulin schema likely contributed significantly to observed outcomes.